Fees

Out of Network Benefits

Submitting for Out-of-Network Insurance BenefitsI may be able to work with you to submit claims for Out-of-Network health insurance benefits. Here is what you need to know:

Instructions For Calling Your Insurance Provider

Call the number on the back of your insurance card for the Benefits Department.

Write down every answer you receive. You'll need careful records later if the company fails to follow through with what they've told you.

Don't be intimidated. Ask for explanations of anything you don't understand.

Ask to speak to a supervisor if you are not happy with the answers you are getting.

Questions to Ask Your Insurance Provider

What is your name and extension number? ­___­­________________________________

Does my policy cover Out-of-Network or LCSWs? ____yes ____no

My therapist is willing to provide a statement of (a) Session Dates Attended, (b) the CPT code, and (c) the Diagnosis. Is this acceptable to the insurance company? ____yes ____no

Does my policy cover:

Individual Psychotherapy? (CPT code 90837) ____yes ____no

What mental health Diagnoses are NOT reimbursable? __________________________

How many Sessions are covered per year? ___________________________________

What is the Lifetime Maximum for mental health benefits? $______

What is my Out-of-Network Deductible? $______

What is the Allowed Amount of the fee? (Please read important note!)

Individual session ($80-$100): $______

What percent of the Allowed Amount will be reimbursed? ______%

How do I file a claim? ____________________________________________________

Important Note: Please read carefully!Many insurance companies will reimburse a percentage of the total fee paid. For example, your company may reimburse you 80% of the total fee paid, or $64 for a $80 individual session. Other companies will substitute the $80 fee for what they deem appropriate, regardless of what you paid. For example, your company may say that they will reimburse you 80% of the “allowed amount” of the fee. You paid $80 for an individual session, but your insurance company only allows $60. Therefore, you will be reimbursed 80% of $60, or $48. They may try to withhold this information from you and can legally do so. Ask to speak to a supervisor and say that you cannot plan your medical expense budget without this number.

Important ConsiderationsInsurance reimbursements will vary from month to month:

At the beginning of therapy, there will be a wait until your insurance company begins to pay your benefit.

In January of each year, you will not get any money back until your deductible is met. If you apply other family medical expenses to your deductible, you will start getting benefits sooner, and more of your therapy will be paid for.

Toward the end of the year, your insurance reimbursements will stop if the number of sessions is limited.

Your out-of-pocket medical expenses can be minimized if your employer offers a pre-tax medical "flexible spending account."Ask your accountant about taking a medical tax deduction for psychotherapy.You may save money with an insurance plan that has a higher premium, but better benefits for out-of-network therapy (called Preferred Provider Organization, or PPO).

Why Do You Not Accept Any Insurance Plans?I currently do not accept any insurance plans for a variety of compelling reasons. Some of these benefits include:

More flexibility in the length of each client's treatment and no strict requirements on reasons for which clients can receive counseling.

More autonomy and decision making power for clients and therapist to design a treatment that best meets each family's needs, rather than following standard insurance requirements

More time spent with families (and less time doing billing paperwork)

More privacy for clients, as I am not required to report information to a third party for billing purposes

"Enter into children's play and you will find the place where their minds, hearts, and souls meet." -Virginia Axline